The government’s proposal for the legal regulation of euthanasia, physician assisted suicide and the termination of a patient’s life without his/her request has been approved by the Dutch Parliament. The defense of the this proposal is, to a large extent, based on a specific interpretation of data published in 1991 in the Remmelink Report. In the course of the discussions that followed this proposal, it has been agreed that the following three categories of action should not be considered forms of euthanasia:
1. Stopping or not beginning a treatment at the request of the patient.
2. Withholding a treatment that is medically useless.
3. Pain and symptom treatment with the possible side-effect of shortening life.
The focus of this paper is to discuss both the inter-relation of the Remmelink Report and other data with the new law and, attempt to undermine the effectiveness of national safeguards and the existence of personal autonomy, under the current system.
The findings of the Remmelink Report disclose that 9,000 requests for physician assisted suicide in the Netherlands led to ‘only’ 2,300 cases of euthanasia (Jochemsen, 212). Such data has been used by euthanasia activists to illustrate that, in reality, physicians in the Netherlands are not, in fact, terminating patients on demand. Indeed, this is not the case; however, more significantly, the data illustrates that the request of the patient is not in practice the basis on which physicians decide to perform euthanasia, but rather they base such decisions on the condition of the patient (Jochemsen, 212). This supports the findings that 1,000 patients had their lives terminated without their consent (Jochemsen, 212). In practice, the request seems to function more as a circumstance making euthanasia legally and perhaps ethically, easier for the physician to perform. Respect for patient autonomy has been put forward as the main argument in favor of the acceptance of euthanasia, however the above research is contradictory and undermines the autonomy of the patient.
The result of the Remmelink Report also indicates that 65-75% of physicians falsely and unlawfully certify death by natural causes after performing euthanasia (Jochemsen, 213). These findings demonstrate that the physicians are reluctant to have their life-terminating actions supervised by legal authorities. Even more alarming is the fact that the data indicates that in majority of cases, it is unknown whether the requirements for careful medical practices are even being observed (Jochemsen 213). Such statements are supported by the recent research by Van der Wal. Some of the most significant results can be summarized as follows:
1. Physicians often fail to inform the proper authorities of the circumstance of their patients death due to their desire to avoid administrative complications, or burden the patient’s family with any investigation.
2. The cases that are reported are representative of a sample of all cases in which the requirements of the court have been met, however, this is less so for the unnoticed cases.
3. The reports of cases that are notified describe the situation of the patient in terms that satisfy the requirements of the legal authorities, some of which, are in conflict with the description give in the anonymous inquiry (Jochemsen, 213). In light of the above research, the ability of legal authorities to adequately control the practice of euthanasia is minimal.
The data collected by the Remmelink Committee illustrate that the Dutch Cabinet’s classification of life-terminating actions, are nuclear. The reportable actions are euthanasia, physician assisted suicide and life-terminating actions (Fernigsen, 167). However, the intensification of pain treatment and the withholding of treatment with the explicit intent of shortening life do not come within the definition of these actions, nor under the definition of those actions that are not to be considered euthanasia. Therefore, it remains difficult to determine, whether in the opinion of the Cabinet, such actions should be reported. It is only in the Memorandum of Reply that the ministers make it clear that the intensification of pain and symptom treatment with the intent to shorten life should not be considered normal medical treatment and must therefore be reported (Fernigsen, 167). This is in conflict with the Remmelink findings, which reports that in 60% of the cases where pain treatment was given in such high doses that life was significantly shortened, there had been no request made by the patient (Jochemsen, 213).
Another source found in The Economist, reports that in addition to 2,300 cases of euthanasia in Holland in 1990, a further 1,040 people had their lives terminated without making a formal request for intervention (Euthanasia, 21).
Such figures give pause for thought. One must question the length to which such practices could continue. Consider the severely depressed 50-year old Dutch woman, who in 1991 asked her psychiatrist named Chabot to assist her in her suicide. After consulting with several other doctors, the psychiatrist, agreed to help her die and gave the patient a large quantity of sleeping pills and a toxic poison. The woman took these pills and died shortly after (Spanjer, 1630). This incident was followed by an inquiry by the supreme court of Holland. However, in June that same year, the psychiatrist was not prosecuted, setting a precedent for future cases (Spanjer, 1630). The ineffectiveness of national safeguards as illustrated by the depressed Dutch woman, adds validity to the slippery slope hypothesis.
Johan Legemaate, legal counsel of the Royal Dutch Medical Association responds to criticism of the manner in which euthanasia is practiced in the Netherlands. He argues that in more than two thirds of the cases where patients request euthanasia, it is denied (Euthanasia, 22). He adds that in most such cases, as cited above, life was shortened only by a matter of hours or days. Legemaate declares, “We feel we have succeeded in creating a large amount of openness and accountability” (Euthanasia, 22). However, determining whether a patient’s life was shortened merely by a matter of hours or days is indeed difficult once the patient’s life has already been terminated. Such logic eliminated the possibility of a misdiagnosis, or improvement, no matter how remote in probability. Moreover, critics counter that the result of the system as it exists, is a climate of indifference in which most cases of euthanasia go unreported and patience’s rights are being eroded (Euthanasia, 23). Such evidence exposes the fallacy of the autonomy of euthanasia. Instead of giving more freedom to the patients, doctors are being given more power over them.
Within the system, as it currently exists in Netherlands, physicians are increasingly being given the power to practice life and death over their patients. Considering the preceding statement, a greater question must be posed. On what basis are value judgments being made with regards to which patients are suitable for euthanasia without the request of the patients themselves? When one comes to such realization, the potential dangers of euthanasia become very pronounced. Those who work with the disabled community have been at the forefront of opposition against the termination of patients (Jennish, 16). Lloyd Samson, 44, a volunteer with the Halifax Regional Cerebral Palsy Association, voices his concern when he declares, “the rights of the disabled must be protected . . . when someone plays God, it’s scary” (Jennish, 16). The Council of Canadians with Disabilities and its member organization, Saskatchewan Voice of the Handicapped, are strongly in opposition of euthanasia (Jennish, 16). The fear of the disabled can by no means be considered unreasonable. The autonomy of the handicapped is clearly in danger of being compromised.
For the community of physicians and nurses, euthanasia is troubling because they are trained to heal and save their patients. Killing a patient, even with noble intentions, is in conflict with the very nature of the medical profession. Furthermore, even with the request of the patient for euthanasia, some physicians, however few, may have ethical reservations about performing such a procedure. Many doctors also fear that practicing euthanasia will lead to some patients to regard them as bringers of death (Economist, 42). The growing palliative care branch of medicine has been at the forefront of medical opposition to euthanasia (Cosh, 22). Practitioners in hospices argue that techniques for controlling pain are now so far advanced that fewer people need die in agony. They are concerned that growing availability of euthanasia as an easy option would diminish the compassionate care of those who prefer to let death take its natural course (Cosh, 22). Admirers of the Dutch system of euthanasia believe it to be the more ‘compassionate’ choice, however, in light of the evidence adduced above, we see an inherent contradiction.
The financial cost for palliative care is sizable, however, recent research has shed new light on the less substantial cost of hospices. Many health care experts assume that a huge chunk of medical cost is spent to briefly extend the lives of those patients whoa re to die anyway (Cosh, 38). But a study published in 1994, in the Journal of the American Geriatrics Society, illustrates the contrary. The report finds that discontinuing life-prolonging treatments for terminally ill patients would in fact, save little money (Cosh, 38). When the study used patients who had a 10% chance of surviving for two months or more, the savings were considerably more. However, when one considers that the lives of human beings are lying in the balance, discussing ‘savings’ becomes extremely inappropriate. Few would argue that we owe our sick and elderly better than what euthanasia proposes. Such policy would inevitably diminish to a climate whereby patients feel the duty to die.
For the Christian churches, there is little division of opinion with regards to the moral and religious justification of euthanasia. Even in the case of the Netherlands, where the overwhelming majority of the population, has lost the habit of attending church on Sundays, remain influenced by Christian values and ideologies (Economist, 43). One of the most fundamental of all Christian beliefs is the sanctity of life. According to the Christian, life is a precious gift from God, which individuals guard but not own. Another is that human suffering is essentially part of our redemption, and as such, is immensely valuable in itself. The Roman Catholic Church has taken this position, but not, however, an active role in protest (Jennish, 17). Walter Farquharson, a former moderator of the United Church, laments that many church members are dissatisfied with the church’s failure to address concerns such as living wills and euthanasia. After exploring various religious aspects of such concerns, he concludes,
We believe that it is appropriate to withdraw medical treatments that are not benefiting the patient and that are prolonging suffering and dying when . . . firm evidence of disease irreversibility exists. (Skoutajan, 949)
However, both Farquharson, the Catholic Church and the vast majority of Christians do not condone the practice of active euthanasia.
Holland has the most liberal euthanasia laws than any other western country. As a case study, the effectiveness of the Dutch system is the source of intense debate. Admirers cite the care with which the Dutch debated the issue until consensus was reached, and the safeguards that they built into their system. However, the evidence adduced above demonstrates the ineffectiveness of safeguards and that Holland is skidding down the slippery slope towards licensed killing. Works Cited
Cosh, Colby. “Wanted, One Doctor Death.” Alberta Report, July 10,
1995. Vol. 22, p.22.
Fenigsen, Richard. “New Regulations Concerning Euthanasia.”
Issues in Law and Medicine, Fall, 1993 p. 167, 7p.
Jennish, Darcy. “What Would You Do?” Macleans, November 28,
1994.
Jochemsen, Henk. “Euthanasia in Holland.” Journal of Medical
Ethics, December 1994.
Skoutajan, Hanns F. “Post-Sacred Society.” Christian Century,
October 18, 1995
“The Dutch Way of Dying.” The Economist, September 17, 1994.
Vol. 332, p21, 3p.
“To Cease Upon Midnight.” The Economist, September 17, 1994.
Vol. 332, p32, 5p.
1. Stopping or not beginning a treatment at the request of the patient.
2. Withholding a treatment that is medically useless.
3. Pain and symptom treatment with the possible side-effect of shortening life.
The focus of this paper is to discuss both the inter-relation of the Remmelink Report and other data with the new law and, attempt to undermine the effectiveness of national safeguards and the existence of personal autonomy, under the current system.
The findings of the Remmelink Report disclose that 9,000 requests for physician assisted suicide in the Netherlands led to ‘only’ 2,300 cases of euthanasia (Jochemsen, 212). Such data has been used by euthanasia activists to illustrate that, in reality, physicians in the Netherlands are not, in fact, terminating patients on demand. Indeed, this is not the case; however, more significantly, the data illustrates that the request of the patient is not in practice the basis on which physicians decide to perform euthanasia, but rather they base such decisions on the condition of the patient (Jochemsen, 212). This supports the findings that 1,000 patients had their lives terminated without their consent (Jochemsen, 212). In practice, the request seems to function more as a circumstance making euthanasia legally and perhaps ethically, easier for the physician to perform. Respect for patient autonomy has been put forward as the main argument in favor of the acceptance of euthanasia, however the above research is contradictory and undermines the autonomy of the patient.
The result of the Remmelink Report also indicates that 65-75% of physicians falsely and unlawfully certify death by natural causes after performing euthanasia (Jochemsen, 213). These findings demonstrate that the physicians are reluctant to have their life-terminating actions supervised by legal authorities. Even more alarming is the fact that the data indicates that in majority of cases, it is unknown whether the requirements for careful medical practices are even being observed (Jochemsen 213). Such statements are supported by the recent research by Van der Wal. Some of the most significant results can be summarized as follows:
1. Physicians often fail to inform the proper authorities of the circumstance of their patients death due to their desire to avoid administrative complications, or burden the patient’s family with any investigation.
2. The cases that are reported are representative of a sample of all cases in which the requirements of the court have been met, however, this is less so for the unnoticed cases.
3. The reports of cases that are notified describe the situation of the patient in terms that satisfy the requirements of the legal authorities, some of which, are in conflict with the description give in the anonymous inquiry (Jochemsen, 213). In light of the above research, the ability of legal authorities to adequately control the practice of euthanasia is minimal.
The data collected by the Remmelink Committee illustrate that the Dutch Cabinet’s classification of life-terminating actions, are nuclear. The reportable actions are euthanasia, physician assisted suicide and life-terminating actions (Fernigsen, 167). However, the intensification of pain treatment and the withholding of treatment with the explicit intent of shortening life do not come within the definition of these actions, nor under the definition of those actions that are not to be considered euthanasia. Therefore, it remains difficult to determine, whether in the opinion of the Cabinet, such actions should be reported. It is only in the Memorandum of Reply that the ministers make it clear that the intensification of pain and symptom treatment with the intent to shorten life should not be considered normal medical treatment and must therefore be reported (Fernigsen, 167). This is in conflict with the Remmelink findings, which reports that in 60% of the cases where pain treatment was given in such high doses that life was significantly shortened, there had been no request made by the patient (Jochemsen, 213).
Another source found in The Economist, reports that in addition to 2,300 cases of euthanasia in Holland in 1990, a further 1,040 people had their lives terminated without making a formal request for intervention (Euthanasia, 21).
Such figures give pause for thought. One must question the length to which such practices could continue. Consider the severely depressed 50-year old Dutch woman, who in 1991 asked her psychiatrist named Chabot to assist her in her suicide. After consulting with several other doctors, the psychiatrist, agreed to help her die and gave the patient a large quantity of sleeping pills and a toxic poison. The woman took these pills and died shortly after (Spanjer, 1630). This incident was followed by an inquiry by the supreme court of Holland. However, in June that same year, the psychiatrist was not prosecuted, setting a precedent for future cases (Spanjer, 1630). The ineffectiveness of national safeguards as illustrated by the depressed Dutch woman, adds validity to the slippery slope hypothesis.
Johan Legemaate, legal counsel of the Royal Dutch Medical Association responds to criticism of the manner in which euthanasia is practiced in the Netherlands. He argues that in more than two thirds of the cases where patients request euthanasia, it is denied (Euthanasia, 22). He adds that in most such cases, as cited above, life was shortened only by a matter of hours or days. Legemaate declares, “We feel we have succeeded in creating a large amount of openness and accountability” (Euthanasia, 22). However, determining whether a patient’s life was shortened merely by a matter of hours or days is indeed difficult once the patient’s life has already been terminated. Such logic eliminated the possibility of a misdiagnosis, or improvement, no matter how remote in probability. Moreover, critics counter that the result of the system as it exists, is a climate of indifference in which most cases of euthanasia go unreported and patience’s rights are being eroded (Euthanasia, 23). Such evidence exposes the fallacy of the autonomy of euthanasia. Instead of giving more freedom to the patients, doctors are being given more power over them.
Within the system, as it currently exists in Netherlands, physicians are increasingly being given the power to practice life and death over their patients. Considering the preceding statement, a greater question must be posed. On what basis are value judgments being made with regards to which patients are suitable for euthanasia without the request of the patients themselves? When one comes to such realization, the potential dangers of euthanasia become very pronounced. Those who work with the disabled community have been at the forefront of opposition against the termination of patients (Jennish, 16). Lloyd Samson, 44, a volunteer with the Halifax Regional Cerebral Palsy Association, voices his concern when he declares, “the rights of the disabled must be protected . . . when someone plays God, it’s scary” (Jennish, 16). The Council of Canadians with Disabilities and its member organization, Saskatchewan Voice of the Handicapped, are strongly in opposition of euthanasia (Jennish, 16). The fear of the disabled can by no means be considered unreasonable. The autonomy of the handicapped is clearly in danger of being compromised.
For the community of physicians and nurses, euthanasia is troubling because they are trained to heal and save their patients. Killing a patient, even with noble intentions, is in conflict with the very nature of the medical profession. Furthermore, even with the request of the patient for euthanasia, some physicians, however few, may have ethical reservations about performing such a procedure. Many doctors also fear that practicing euthanasia will lead to some patients to regard them as bringers of death (Economist, 42). The growing palliative care branch of medicine has been at the forefront of medical opposition to euthanasia (Cosh, 22). Practitioners in hospices argue that techniques for controlling pain are now so far advanced that fewer people need die in agony. They are concerned that growing availability of euthanasia as an easy option would diminish the compassionate care of those who prefer to let death take its natural course (Cosh, 22). Admirers of the Dutch system of euthanasia believe it to be the more ‘compassionate’ choice, however, in light of the evidence adduced above, we see an inherent contradiction.
The financial cost for palliative care is sizable, however, recent research has shed new light on the less substantial cost of hospices. Many health care experts assume that a huge chunk of medical cost is spent to briefly extend the lives of those patients whoa re to die anyway (Cosh, 38). But a study published in 1994, in the Journal of the American Geriatrics Society, illustrates the contrary. The report finds that discontinuing life-prolonging treatments for terminally ill patients would in fact, save little money (Cosh, 38). When the study used patients who had a 10% chance of surviving for two months or more, the savings were considerably more. However, when one considers that the lives of human beings are lying in the balance, discussing ‘savings’ becomes extremely inappropriate. Few would argue that we owe our sick and elderly better than what euthanasia proposes. Such policy would inevitably diminish to a climate whereby patients feel the duty to die.
For the Christian churches, there is little division of opinion with regards to the moral and religious justification of euthanasia. Even in the case of the Netherlands, where the overwhelming majority of the population, has lost the habit of attending church on Sundays, remain influenced by Christian values and ideologies (Economist, 43). One of the most fundamental of all Christian beliefs is the sanctity of life. According to the Christian, life is a precious gift from God, which individuals guard but not own. Another is that human suffering is essentially part of our redemption, and as such, is immensely valuable in itself. The Roman Catholic Church has taken this position, but not, however, an active role in protest (Jennish, 17). Walter Farquharson, a former moderator of the United Church, laments that many church members are dissatisfied with the church’s failure to address concerns such as living wills and euthanasia. After exploring various religious aspects of such concerns, he concludes,
We believe that it is appropriate to withdraw medical treatments that are not benefiting the patient and that are prolonging suffering and dying when . . . firm evidence of disease irreversibility exists. (Skoutajan, 949)
However, both Farquharson, the Catholic Church and the vast majority of Christians do not condone the practice of active euthanasia.
Holland has the most liberal euthanasia laws than any other western country. As a case study, the effectiveness of the Dutch system is the source of intense debate. Admirers cite the care with which the Dutch debated the issue until consensus was reached, and the safeguards that they built into their system. However, the evidence adduced above demonstrates the ineffectiveness of safeguards and that Holland is skidding down the slippery slope towards licensed killing. Works Cited
Cosh, Colby. “Wanted, One Doctor Death.” Alberta Report, July 10,
1995. Vol. 22, p.22.
Fenigsen, Richard. “New Regulations Concerning Euthanasia.”
Issues in Law and Medicine, Fall, 1993 p. 167, 7p.
Jennish, Darcy. “What Would You Do?” Macleans, November 28,
1994.
Jochemsen, Henk. “Euthanasia in Holland.” Journal of Medical
Ethics, December 1994.
Skoutajan, Hanns F. “Post-Sacred Society.” Christian Century,
October 18, 1995
“The Dutch Way of Dying.” The Economist, September 17, 1994.
Vol. 332, p21, 3p.
“To Cease Upon Midnight.” The Economist, September 17, 1994.
Vol. 332, p32, 5p.
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